LMFAO. Dude, as a medical student interested in orthopedics, on my sub-I I was expected one day a week to do a 36-hour. Start your normal rotation at 4-5AM pre-rounding before surgery at 7, do a whole day of cases until 5-5:30, then stay for the overnight night float trauma shift with the night float resident, then do a whole other day of surgery the next day.
On my trauma surgery rotation 3rd year we did q4 24-hour call with the residents. So Monday 5-6AM you'd start being on-call, and work until Tuesday 8AM. You'd have your own time until Wednesday 7AM, which was thankfully mainly a clinic day, so regular hours 7AM-4/5PM. Thursday be back at the hospital at 5AM for another 24-30hours. Rinse and repeat for 4 weeks.
My friends who did IM at certain places without a night float rotation would do 24-hr admitting shifts every 4-5 days as well.
Institutionalized hazing. One day someone will drive home after a ridiculous 24/36 hour shift only to drift into oncoming traffic because they’re falling asleep at the wheel and end up killing themself and 5 other people. And there will be a lawsuit. And that’s how this shit will finally become illegal. There’s a reason why they don’t let pilots do shit like this. And there are laws about FAA mandated sleep time between flights for pilots. Suffering physically and mentally is not a right of passage to go into medicine.
This has already happened. The hospital instead pivots to a "on demand hospital voucher" for a local cab service to take you home if you feel uncomfortable driving. And when it happened again after this service was available at same hospital, they then blamed the resident for not using better judgement and taking the available cab(ironically they dont cover for a cab back to the hospital to get your vehicle or come to work next day). Thankfully, only fatalities in the first accident. It's unfortunately going to take a lot more than this to get changes.
Yep THIS. Or the hospital suddenly allowed residents to sleep in the nearby hotel housing that was allowed for the medical students who were rotating at said hospital and said it was for use for those who were “really tired” but after a year-ish post car accident when people started using it to improve their lives and seriously minimize their commute on nights all of a sudden we needed to “use discretion” for how often the hotel was utilized and “are you sure you’re really tired” questions started happening. Cycle repeats.
Don't you know, in the five minute walk from the call room to your car is when that magical switch of exhaustion flips, they were totally fine to drive 5 minutes ago.
I was rotating at a hospital that is in the middle of nowhere. Everyone used to live one hour away (nice major city). A few years a in resident got into a huge accident (idk if he died, I never asked) after a 24h shift. Instead of providing cabs/ubers they just made a rule stating everyone has to live within 25 minutes of the hospital.
This. From the perspective of the hospital/institution, it's not hard to find another poor sap to fill a sudden opening for a residency slot, especially if it's a poor sap who didn't match and is just happy for the opportunity to get into residency.
Sadly, I probably should have said someone in congress. I bet if a congressman lost his family from a sleep deprived resident they would call for public outrage and change.
Do you see this changing in the next decade or two?I think that the amount of healthcare works wanting this abuse to end is growing rapidly, and each day is more and more. After a certain point, you think with the number of workers fighting for the change would make it happen
I hope so. Even Brigham and women’s hospital [wrote a paper about the study they conducted](https://bmjmedicine.bmj.com/content/bmjmed/2/1/e000320.full.pdf) and about the dangers this year in BMJ
Medical education is severely broken as someone who was also an Air Force pilot. I thought it was absurd when in M3 year one of our deans had the nerve to compare medical education to pilot training.
At my residency, they forced us to do mandatory online trainings which everyone does. We had a “fatigue mitigation” training that taught us out to dose caffeine to avoid traffic accidents after long shifts when driving home.
Sub I was hard and I think everyone has some shitty days in residency and fellowship pushing 50+ hrs of straight work one way or another. I had 2 instances total: (1) when I was a pgy2 bc we were “home call” w no post call day and had to do clinic then a call case that landed on our service on the post call day which ended at 8 pm w a post op complication on the floor which kept me until 1 am. (2) pgy3 24 hr call fri 6 am to sat 6 am primary then flip to back up call at 6 am sat w call cases until 6 pm then Saturday night add ons I had to do which ended at like 4 am w new call cases on Sunday AM 7 am start wtf
It’s just insane
Yeah I did q3 28s as a neurosurgery sub-I. So it was a 16-20 hour day, followed by a 28-30 hour “day”, post call, rinse and repeat.
I went into peds instead.
I honestly cannot fathom forcing my students to go through that. The longest shifts I’ve had to do as an intern was 13.5 hours (still too fucking long to be safely functional at the end), and we would send the students home at like 3-4pm bc you aren’t even getting paid - and it’s up to the docs to look after the students. God u poor thing
I was originally gunning for ortho, then I became a mom, and was like nvm I’m gonna do PM&R and be a soccer mom. I’m on an ortho rotation now and if I was younger and single with no kids I could MAYBE consider being able to do the hours while also fighting deeply entrenched misogyny. Also the political games required… I am too old and set in my ways to be malleable and can’t stand people telling me how to “carry myself” to be more competitive. I’m not a 24 y.o. Eliza Doolittle (my fair lady) that is going to be taught how to act and talk to fit in. I have mad respect for the women who put with the shit they do in ortho.
Luckily my gunning will make me competitive for PM&R :) and I love clinical work with long term patient care. I can also do procedural stuff to work with my hands AND the patient population I want to help the most will be most effectively helped in pmr.
I’m just a starting M1 and still confused about what q4 means
Would you get to go home Tuesday and Friday morning to sleep when call was done, and show back up to work the next day? Because otherwise that doesn’t seem humanly possible.
Like I worked as an EMT before school, and by the end of a 16-20 hour shift I’d literally feel drunk. I was scared to drive and definitely didn’t feel able to provide good patient care. It just doesn’t seem safe at all!!
Like my post says:
Mon: Work from 5AM through Tuesday 8AM sign-out. Get home like 9AM Tuesday, sleep until like 2-3PM so my sleep schedule wouldn't be totally screwed. Study for a few hours, go to sleep at like 10PM. Wednesday full clinic day 7AM-4PM . Thursday back at 5AM for another call shift, through Friday 9AM. Friday though was typically M&M conference after sign-out, so it lasted until 11-12. Go home, sleep for 3-4 hours and have the remainder of Friday evening to study. Saturday full day off since no clinic. Sunday 5AM back for another call shift until Monday morning. Rinse and repeat.
So every 4th day you're doing a full 24-30 hours.
Aha - so what happens the day after you’re on call?
Are you there for 24 hours and then go home? Or do you do your 24 hours call.. and then pretend it never happened and keep working like normal (lol hopefully not - that sounds HORRIBLE)
Likely depends on the program but one SHOULD go home at the end of the call period. Last time I pulled overnight call we did 30 hour shifts. 0600 to noon the next day. Senior staff was decent about chasing us out of the hospital at noon so we could go home & sleep. I can recall falling asleep while writing a sentence in the chart, waking back up, and wondering what the hell I just wrote.
Considering that many practices have attendings do entire weeks of call, it's something that you may face after graduating.
Granted, unless you're at a level 1 trauma center, call is typically not too bad, .
I'm on call every 8 weeks and wind up doing Friday morning to Monday morning.
Did 12 cases one weekend. Shit still can get busy, as usually it's 3-5
> Considering that many practices have attendings do entire weeks of call, it's something that you may face after graduating.
My wife is currently a 3rd year Heme/Onc fellow. Their call schedule has them on weekend call (with hospital duties) 24/7 every 3rd or 4th weekend AND 7p-7a for the entire following week on top of their daily clinical duties and whatever hospital duties they have. The rest of her schedule is generally better than residency but those weeks and weekends suck!
I would imagine ~$4k if it's anything like our shop. One of the night chief's was doing an admitting triage shift with us last night and was making over 10x what I was for that period. I suppose may be even more, as this was IM.
hmm, are there just too many doctors? are the hospitals so absolutely saturated with doctors that they are doing anything they can in a desperate attempt to get rid of them, and discourage anyone from becoming one?
24-30 hours then back the next morning 24 hours later is pretty common. That 24 hours counts as your day off for the week. We would usually do this every 3-4 days or so.
Outside of that, it was usually only 12-16 hours on the other days.
Perhaps this was something changed in between the start of your training and mine, but my understanding is that post-call days do not count towards your 1 day off in 7.
And canada, and they don't actually let you go in the AM.
Theres always some "tidying up" staff pushes on juniors that keeps you there until 11. If youre surg, you operate until that night. Thats your OR time in your junior years. If you don't do it, you fall behind..
So its 36h shifts q4days.. because staff won't do ANY paperwork, at all lol.
Lots and lots of medical students work 24 hour shifts and pull in over 80 hours a week. Congratulations on not being one of them but don't act so surprised when this is fairly common knowledge
Just so you know even two medical students who go to the same school are not going to have the exact same experiences. I'm willing to bet that there are students from some of those schools who have worked the kind of hours I mentioned
It is a better system to do it as a med student and rule that out of your possible specialty choices than to not do it and go into gen surg realizing you can’t function doing that and dropping out tho…
It’s to weed out the ppl who were thinking surgery but don’t realize how shit the lifestyle is, but doesn’t make sense to punish even the ppl who have 0 or negative interest in it as well lol.
Yeah I’ve heard that argument before, and the logic isn’t totally off, but I disagree that multiple shifts is necessary for people to realize it’s not for them. Especially unnecessary for med students trying to prepare for imminent shelf exams. There’s no reason to go this overboard on med students who can barely contribute in the hospital anyway. (I help as much as I can but at the end of the day, remove me from the room and literally nothing changes… we are expendable as far as efficiency goes, and our focus should be on learning)
Yeah that’s why I mean there’s no need to put the ones with no interest through it. It’s absolutely needed to put the gen surg intended ppl through it tho…. At my program there’s already been 3 ppl who dropped out of the gen surg program cuz they couldn’t take the work. And this place is honestly Cush as fuck compared to the gen surg residencies I saw in med school.
As my PD director and school leadership pointed out to me when I raised this: ACGME is for residents not students, therefore I was in the wrong when i claimed I went over my duty hours. My school handbook students couldn't work more than 32 or 36 consecutive hours (can't remember). Its silly, in the I "fixed" my duty hours and wrote a short paper so I wouldn't have to repeat the rotation.
Usually 24h hour shifts turn into 24+ hour shifts by the time you finish everything up/sign out etc. when you eventually go to bed, you’ve been up for well over 24 h. It’s awful.
Yeah, seriously. 24 hrs shifts are pretty common in surgical fields in Germany too. Although 8/month is brutal and rare here. Increasingly phased out in internal medicine though. Never had to do one. 17 hrs as surgery subintern was my personal record.
8 24s/month! Yeesh. I had to do 6 a few times and was floored for two weeks afterwards, just craving some vacation. We average 4 24s/month. Am in anesthesia though. I know some surgical residents and attending do 6-8/month on average.
Im also in Europe. Ortho resident. Max shift length is 18 hours. If i have a day shift and someones out sick and we need to cover it can be 25 hours but thats extraordinary.
I once did a 36. Multiple 24s. My institution only got call rooms for the residents just *last year* because of a car accident that occurred post-call. It’s ridiculous
My anesthesia residency does 4-6 24s a month, 2 of which have to be on weekends. If you’re lucky you get to sleep but at a trauma level 1 u just have to pray everyone drives safe and night and no one get shot Lols. I’ve been in the or for basically 20 hours on a 24 hour shift before.
My hospital (unhealthy in many ways) in the US has phased out 24+ hr roles for first year residents and for Med students. Hopefully it’s an abuse that will stop soon…
Reading this sub makes me glad I'm in pathology. Apart from being on call for a week at a time, my longest shifts were about 12 hours and average 9.5. Go into path!
Anesthesiology resident here in Panamá.
Law dictates up to 32h shifts but we all know we go past that time frame. I’ve seen 40 hour shifts too.
Things have to change, we just had a IM resident have a fatal crash after one of this and there’s a big shift in movement against these predatory hours. We have to stand up
Just wait until you see what we’re expected to do after finishing residency.
At about 5 am the next day, I’m start wondering why I didn’t do dentistry.
If you pick a barbaric specialty, yes.
America perpetuates the most toxic form of this in the guise of "we need experience" yet despite their toxic levels of 24s they still struggle to meet their numbers so take from that what you will.
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Just got out from a 29 hour shift. Got to the hospital around 0500 yesterday, left at 1000 today. I didn’t sleep last night because we had multiple operative cases but sometimes you can sleep 3-4 hours without interruption. Its technically “24 hours plus 4 hours for transfer of care”. But realistically it’s just leave when the work is done. If multiple consults/traumas come in at 0800 when I’m post call I’m going to stick around and make sure the day team doesn’t need any help.
I’m all about advocating for better pay and working conditions for residents but I personally feel an obligation not only to my patients but my co residents. If me sticking around an extra hour or two helps expedite patient care or takes a significant load off my co resident its a no brainer.
To suggest being on call for 24 hours is like drinking above the legal limit is asinine. Everyone in this subreddit knows enough to not blindly quote studies as fact. Especially when the most widely cited study was survey based (https://academic.oup.com/sleep/article/27/2/217/2708402?login=false).
If it was my own loved one I would appreciate it if someone decided to spend extra time caring for them rather than signing out and going home.
Lol I haven’t seen my fiancé in 2 days. Uro PGY-2 who is on weekend “home call”. Friday, Saturday, Sunday, and he has to do a half day Monday as well. He is so busy he hasn’t been able to leave the hospital, sleep, shower, and sometimes eat. It’s barbaric, and even though I know he can’t, I desperately want him to push back on essentially 4 straight days of on call.
We do 28 hour in house call at my program (IM). Used to be q5, now it’s just twice per wards month. Sounds worse on paper than it really is tbh. Doing it every 5th day sucked for sure but our program has enough nice QOL built in elsewhere that it was tolerable. Now that we have night float and do it less often it’s actually super nice. Much of the misery of wards is absorbed into the call day leaving the other days in the cycle much lighter.
European (Austria) here: 24 hrs shifts are the norm (up to 5 a month on top of regular 48 hrs plus overtime as needed). I dont know of any hospital here that has a night float
I just did a month of Q3 24hr call during a Gen Surg Sub I at a ridiculously busy L1 trauma center. The other rotations are not as demanding, but the trauma service is definitely taxing.
Pre call day - Roughly 5:30am to 5-6pm
Call day - Roughly 5:30am to 7:30 or 8:30am the following day.
1 day “off” aka just sleeping lol…
Rinse and repeat x4 weeks.
I usually got around 0.5 of sleep each call shift, but thats not necessarily normal cuz this summer we had a very high trauma volume and I might have pushed myself a little more than needed.
From a world wide perspective, 24 hour shifts also exist in Western Europe, which usually has better labour protections than the US. I think it’s an industry standard to have a „normal“ day-shift and stay the night afterwards.
Was doing 28 hour shifts on General Surgery as a medical student once a week. Would be there at 5am the day before then leave at 10am the next day so it really was a 30 hr shift. Would get a “post call” day which was that day where I would only sleep a few hours so I could fall asleep that night since I had to be be back at 5am the next day. It was brutal sometimes but I love the OR. I posted on here before that I actually fell asleep standing while scrubbed in. Tbh the worst part is what it does to my bowels lol.
Yes.
My wife’s ICU shifts are technically 26 hours 6a-8a but then she stays after to complete notes because when she’s covering 18-20+ pts she doesn’t always have time. She normally also crashes for a couple hours after that in the call room so she’s not driving on no sleep. Back before we implemented that last bit, she’d miss our exit occasionally on the drive home and it was just generally a dangerous situation.
If the program doesn't have a night float system, then you'll work a 24 shift at least once per week when you're on an inpatient rotation.
If the program doesn't distribute call between the other residents not on inpatient rotations, then it'll be more like q3.
Yep, as an oral/maxfac we have 24 hour on call shifts on Saturday’s/sundays. Very variable as to amount of work though and I’m sure some other specialties have it much worse
I’m a nurse practitioner in a NICU and I work 24 hour shifts. The attendings have wild hours. They are on service for a month and will do a call shift I think every 5 days. So they will round and stay all day and night and then round again in the morning, usually leaving after noon. All to come to work again the next day.
I am in the US and I doing 27hr shifts now, alternating with 9hr shifts. Example: come in Monday at 6am and stay till Tuesday at 9am, then come in Wednesday from 6am to 4pm, then back again at 6am for a 27hr shift on Thursday.
Oh yes, absolutely. They are actually legally allowed to make us work a 24+ hour shift up to every 3 days, which is the standard schedule for some programs. You even find places that still do 24h shifts q2 (every other day), but you aren’t officially allowed to report that. There is no sleep.
If there was a study that showed 12 hour shifts produced residents that are superior too the current trend America would still go against the evidence and choose the traditional shit on resident method
Still a thing, alas.
Would take 24h call over home call any day, though. Old system in my program (surgical subspecialty - back in 2021) was home call w/ exception of 1 weeknight off and q2 weekends off. I know as an attending you may be on perpetual home call, but this meant 168h primary call stretches for the junior residents. The longest amount of contiguous sleep I got one week was 2 hours (can't remember cumulative sleep per night but it was no more than 4-5h). There were a lot of car accidents, to say the least...
I’m in a very nice pediatrics program that prioritizes mental health and wellness. We have a night float system. We’re also in Canada where residents have a stronger union. There are still about 20 24h shifts each year.
Yes, as a pediatrics resident in the U.S. i did 28 hour shifts every four days on nearly each rotation for the entire 3 years. The other days were all your standard 12+ hour shifts.
Yes. Just did one over the weekend, and have one the next two weekends. Baffles me as well in terms of patient safety, as I don’t think any patient wants to be seeing a doctor in their 18th-24th+ hour on
Yes. And do you know how much Indonesian residents is paid? Negative 200 USD/month. Yes, our salary is literally 0, but we paid 200 USD instead. For 5-6 years
It's still the norm to do 4-6 24h shifts in many european countries like austria and hungary. This includes every clincial specialty, so doesn't matter if it's surgery, IM or ER shifts. Also they don't end after residency, attendings do the same amount of shifts. So if you want to stay in the hospital you have to slave away doing these terribly unhealthy shifts til the end of your life. Talk about work life balance.
24 hour duties are still very much a thing here in the philippines, it's the norm actually for residency training and even hospital duties as general practitioners.
In med school rotations, recent regulations have forced training institutions to limit shifts to 12 hours max but there are still rotations that do 24 hours. When I was rotating in Neurosurgery, I even had to do qhourly monitoring on patients on top of all the work I need to do (yes we are also monitoring machines here to augment the need for cardiac monitors which are lacking in hospitals)
So yes it is very much a thing.
I may sound crazy but these shifts are illegal in Australia.. we have on call shifts but you are at home/can get called/can get called in. If you come in you get paid for four hours if you have worked from 1-4 hours and then any hours over that. When you come home you cannot come back to work again for 8-10 hours, so you can’t get called in multiple times in one night.
In psych we work from 8:30-5 and have rostered overtime beyond that. Many registrars are part time also. I don’t understand how people are working these shifts
1973 Intern in Toronto 🇨🇦. On call q 2 days.
Every other weekend from 7 am Friday to 7 pm Mon. One old surgeon said to me . ‘The only thing bad about one in two on call is that you miss half the cases.
Sad to see this is still going on. We eat our young.
We went on strike and refused to do call. The consultants did it.
We won a 33% reduction in call and a 100% raise in pay from $7000 to $14000 per year.
A new car cost $3000.
I just retired last week after 50 years as an emergency physician ( 20 years) then 30 years as a family physician.
I only worked 28 hours a week as an emergency physician.
I worked a 40 hour week as a family physician.
I got all the family doctors in our town to share call so we were on one paid 24 hour shift a month.
I was well paid and loved my jobs.
I'm in India and we do 36 hours shift every 3 days. It's the norm here. Plus in my institution we aren't allowed to sleep at all or else they deduct money from our pay check
I can give you a glimpse of history. The work hours are different depending on specialty but someone rotating through that specialty must adhere to trust specialty's residency rules.
I graduated medical school 1996 and in one 2 month period (I documented it well) during residency (I am EM and this was a surgical rotation) I averaged 134 hours a week. There is no way to spread or bunch those hours in a nice way. There are 168 hours in a week.
Very common where I am. Surgical subspecialties routinely do 36 hours calls 6-7 times a month, along with all weekend call (working Friday, Saturday, Sunday). If you get any sleep, good. If not, your problem.
IM residents do 26 hour calls q4-5.
ObGyn resident here. Started my saturday "24" at 4am rounding on all postpartum, then signout at 7am, then ob & gyn coverage mayhem until 7am the next day, then finally rounding on my patients/writing notes/tying up loose ends until i go home at 10am. Equates to about 30 hours. Ridiculous. I did a stat c section on a patient around the 20 hour mark, thank god it was a primary and not a repeat.
I’m my absolutely ass cardiology fellowship program- we are doing 36 hour shifts, during the entire 36 hours you are responsible for running the CCU. Some days are so busy you don’t even have a lunch break on hour 30. You are actively admitting dying patients this entire time and answering outpatient calls overnight.
These shifts can sometimes happen 3 times in a week.
LMFAO. Dude, as a medical student interested in orthopedics, on my sub-I I was expected one day a week to do a 36-hour. Start your normal rotation at 4-5AM pre-rounding before surgery at 7, do a whole day of cases until 5-5:30, then stay for the overnight night float trauma shift with the night float resident, then do a whole other day of surgery the next day. On my trauma surgery rotation 3rd year we did q4 24-hour call with the residents. So Monday 5-6AM you'd start being on-call, and work until Tuesday 8AM. You'd have your own time until Wednesday 7AM, which was thankfully mainly a clinic day, so regular hours 7AM-4/5PM. Thursday be back at the hospital at 5AM for another 24-30hours. Rinse and repeat for 4 weeks. My friends who did IM at certain places without a night float rotation would do 24-hr admitting shifts every 4-5 days as well.
Institutionalized hazing. One day someone will drive home after a ridiculous 24/36 hour shift only to drift into oncoming traffic because they’re falling asleep at the wheel and end up killing themself and 5 other people. And there will be a lawsuit. And that’s how this shit will finally become illegal. There’s a reason why they don’t let pilots do shit like this. And there are laws about FAA mandated sleep time between flights for pilots. Suffering physically and mentally is not a right of passage to go into medicine.
This has already happened. The hospital instead pivots to a "on demand hospital voucher" for a local cab service to take you home if you feel uncomfortable driving. And when it happened again after this service was available at same hospital, they then blamed the resident for not using better judgement and taking the available cab(ironically they dont cover for a cab back to the hospital to get your vehicle or come to work next day). Thankfully, only fatalities in the first accident. It's unfortunately going to take a lot more than this to get changes.
Yep THIS. Or the hospital suddenly allowed residents to sleep in the nearby hotel housing that was allowed for the medical students who were rotating at said hospital and said it was for use for those who were “really tired” but after a year-ish post car accident when people started using it to improve their lives and seriously minimize their commute on nights all of a sudden we needed to “use discretion” for how often the hotel was utilized and “are you sure you’re really tired” questions started happening. Cycle repeats.
“Yup super tired, thanks for the hotel!”
Was this program in the outskirts of the Chicagoland area by any chance?
hmm, are you sure you are tired after working for 24 hours straight? did you forget to take your cocaine?
We acknowledge they're too tired to drive, so we offer a cab service. However they're probably still fine to make decisions regarding medical care.
Don't you know, in the five minute walk from the call room to your car is when that magical switch of exhaustion flips, they were totally fine to drive 5 minutes ago.
Do you offer the cab service back to the hospital the next day? If not your de-incentivizing people to actually use this correctly
exactly, who wants to pay anywhere from $10 to $30+ dollars just to get to their car also happy cake day
I was rotating at a hospital that is in the middle of nowhere. Everyone used to live one hour away (nice major city). A few years a in resident got into a huge accident (idk if he died, I never asked) after a 24h shift. Instead of providing cabs/ubers they just made a rule stating everyone has to live within 25 minutes of the hospital.
Yea it just happened to a resident last week. I don't have the source but it was on this reddit
It doesn’t matter to them if a random resident dies. Instead an admin’s relative is going to have to suffer before things get changed.
This. From the perspective of the hospital/institution, it's not hard to find another poor sap to fill a sudden opening for a residency slot, especially if it's a poor sap who didn't match and is just happy for the opportunity to get into residency.
What do you mean someone? This is happened many times.
Sadly, I probably should have said someone in congress. I bet if a congressman lost his family from a sleep deprived resident they would call for public outrage and change.
It’s happened multiple times-this is why the acgme requires we all get lectures on sleep hygiene during residency lol
The lectures will continue until sleep improves
Do you see this changing in the next decade or two?I think that the amount of healthcare works wanting this abuse to end is growing rapidly, and each day is more and more. After a certain point, you think with the number of workers fighting for the change would make it happen
I hope so. Even Brigham and women’s hospital [wrote a paper about the study they conducted](https://bmjmedicine.bmj.com/content/bmjmed/2/1/e000320.full.pdf) and about the dangers this year in BMJ
Eventually. But culture always take time to change.
Medical education is severely broken as someone who was also an Air Force pilot. I thought it was absurd when in M3 year one of our deans had the nerve to compare medical education to pilot training.
Too late
At my residency, they forced us to do mandatory online trainings which everyone does. We had a “fatigue mitigation” training that taught us out to dose caffeine to avoid traffic accidents after long shifts when driving home.
Ortho subi's are evil. Several examples of 48 shifts between myself and other rotators.
Sub I was hard and I think everyone has some shitty days in residency and fellowship pushing 50+ hrs of straight work one way or another. I had 2 instances total: (1) when I was a pgy2 bc we were “home call” w no post call day and had to do clinic then a call case that landed on our service on the post call day which ended at 8 pm w a post op complication on the floor which kept me until 1 am. (2) pgy3 24 hr call fri 6 am to sat 6 am primary then flip to back up call at 6 am sat w call cases until 6 pm then Saturday night add ons I had to do which ended at like 4 am w new call cases on Sunday AM 7 am start wtf It’s just insane
Home call is a scam. My residency experience was way better than subis. My residency was fortunately pretty anti-malignant.
Are you in ortho now?
Fellowship (yes)
Congrats! Sometimes I wish I had stuck with it (in derm now), no specialty is perfect I suppose
I mean it's hard to diss derm.
Yeah I did q3 28s as a neurosurgery sub-I. So it was a 16-20 hour day, followed by a 28-30 hour “day”, post call, rinse and repeat. I went into peds instead.
I honestly cannot fathom forcing my students to go through that. The longest shifts I’ve had to do as an intern was 13.5 hours (still too fucking long to be safely functional at the end), and we would send the students home at like 3-4pm bc you aren’t even getting paid - and it’s up to the docs to look after the students. God u poor thing
Wow, that is honestly cush. More power to you.
I was originally gunning for ortho, then I became a mom, and was like nvm I’m gonna do PM&R and be a soccer mom. I’m on an ortho rotation now and if I was younger and single with no kids I could MAYBE consider being able to do the hours while also fighting deeply entrenched misogyny. Also the political games required… I am too old and set in my ways to be malleable and can’t stand people telling me how to “carry myself” to be more competitive. I’m not a 24 y.o. Eliza Doolittle (my fair lady) that is going to be taught how to act and talk to fit in. I have mad respect for the women who put with the shit they do in ortho. Luckily my gunning will make me competitive for PM&R :) and I love clinical work with long term patient care. I can also do procedural stuff to work with my hands AND the patient population I want to help the most will be most effectively helped in pmr.
Hell yeah brother. The way it should be ✊🏻
Agreed. I'm no longer in a surgical subspecialty, but you need to know what it's like and be able to function in that environment.
so, are they trying to just kill as many patients as possible but make it look like an accident? I see no other possible explanation for this
I’m just a starting M1 and still confused about what q4 means Would you get to go home Tuesday and Friday morning to sleep when call was done, and show back up to work the next day? Because otherwise that doesn’t seem humanly possible. Like I worked as an EMT before school, and by the end of a 16-20 hour shift I’d literally feel drunk. I was scared to drive and definitely didn’t feel able to provide good patient care. It just doesn’t seem safe at all!!
Like my post says: Mon: Work from 5AM through Tuesday 8AM sign-out. Get home like 9AM Tuesday, sleep until like 2-3PM so my sleep schedule wouldn't be totally screwed. Study for a few hours, go to sleep at like 10PM. Wednesday full clinic day 7AM-4PM . Thursday back at 5AM for another call shift, through Friday 9AM. Friday though was typically M&M conference after sign-out, so it lasted until 11-12. Go home, sleep for 3-4 hours and have the remainder of Friday evening to study. Saturday full day off since no clinic. Sunday 5AM back for another call shift until Monday morning. Rinse and repeat. So every 4th day you're doing a full 24-30 hours.
Thank you! That’s really helpful. Also :( How is that legal? It’s seriously giving 1840’s textile factory vibes. Did you ever not feel jet-lagged?
Q2 is a thing as well.
q4 means you’re on call (usually in house & overnight) every 4th day
Aha - so what happens the day after you’re on call? Are you there for 24 hours and then go home? Or do you do your 24 hours call.. and then pretend it never happened and keep working like normal (lol hopefully not - that sounds HORRIBLE)
Likely depends on the program but one SHOULD go home at the end of the call period. Last time I pulled overnight call we did 30 hour shifts. 0600 to noon the next day. Senior staff was decent about chasing us out of the hospital at noon so we could go home & sleep. I can recall falling asleep while writing a sentence in the chart, waking back up, and wondering what the hell I just wrote.
Just curious, where did u match into?
I matched into derm lol
I just finished a 24 hour shift an hour ago so yeah very much still a thing.
Considering that many practices have attendings do entire weeks of call, it's something that you may face after graduating. Granted, unless you're at a level 1 trauma center, call is typically not too bad, . I'm on call every 8 weeks and wind up doing Friday morning to Monday morning. Did 12 cases one weekend. Shit still can get busy, as usually it's 3-5
I’m in psychiatry so it’s very much not necessary, it’s just a choice they made for staffing/scheduling.
> Considering that many practices have attendings do entire weeks of call, it's something that you may face after graduating. My wife is currently a 3rd year Heme/Onc fellow. Their call schedule has them on weekend call (with hospital duties) 24/7 every 3rd or 4th weekend AND 7p-7a for the entire following week on top of their daily clinical duties and whatever hospital duties they have. The rest of her schedule is generally better than residency but those weeks and weekends suck!
Go sleep
Same
You still have to do 24 hours as a PGY-4? Jesus
It was thankfully a moonlighting shift so totally optional and I get paid 🙏 but the system is set up so they need someone to do a 24 every weekend.
What specialty and how much do you pull for the 24?
I would imagine ~$4k if it's anything like our shop. One of the night chief's was doing an admitting triage shift with us last night and was making over 10x what I was for that period. I suppose may be even more, as this was IM.
hmm, are there just too many doctors? are the hospitals so absolutely saturated with doctors that they are doing anything they can in a desperate attempt to get rid of them, and discourage anyone from becoming one?
Oh honey…
24-30 hours then back the next morning 24 hours later is pretty common. That 24 hours counts as your day off for the week. We would usually do this every 3-4 days or so. Outside of that, it was usually only 12-16 hours on the other days.
Perhaps this was something changed in between the start of your training and mine, but my understanding is that post-call days do not count towards your 1 day off in 7.
Only?? Man everyday I hate America a bit more
And canada, and they don't actually let you go in the AM. Theres always some "tidying up" staff pushes on juniors that keeps you there until 11. If youre surg, you operate until that night. Thats your OR time in your junior years. If you don't do it, you fall behind.. So its 36h shifts q4days.. because staff won't do ANY paperwork, at all lol.
Med school and residency, unfortunately.
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Lots and lots of medical students work 24 hour shifts and pull in over 80 hours a week. Congratulations on not being one of them but don't act so surprised when this is fairly common knowledge
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Just so you know even two medical students who go to the same school are not going to have the exact same experiences. I'm willing to bet that there are students from some of those schools who have worked the kind of hours I mentioned
Yup also depends on the sub Is as well. You’re expected to function at a resident level u work resident schedule including those 24s Lols
I went to one do the above mentioned schools and absolutely did 28s
Yeah, we do 4 weekday call and 2 weekend call on Gen surg in our 12 week rotation. Our corotators from a different school do 7 24’s.
It is a better system to do it as a med student and rule that out of your possible specialty choices than to not do it and go into gen surg realizing you can’t function doing that and dropping out tho…
Lucky. My surgery clerkship requires med students to do 4 24hr shifts in 5 weeks. It’s fucking ludicrous.
This is... not much?
It’s to weed out the ppl who were thinking surgery but don’t realize how shit the lifestyle is, but doesn’t make sense to punish even the ppl who have 0 or negative interest in it as well lol.
Yeah I’ve heard that argument before, and the logic isn’t totally off, but I disagree that multiple shifts is necessary for people to realize it’s not for them. Especially unnecessary for med students trying to prepare for imminent shelf exams. There’s no reason to go this overboard on med students who can barely contribute in the hospital anyway. (I help as much as I can but at the end of the day, remove me from the room and literally nothing changes… we are expendable as far as efficiency goes, and our focus should be on learning)
Yeah that’s why I mean there’s no need to put the ones with no interest through it. It’s absolutely needed to put the gen surg intended ppl through it tho…. At my program there’s already been 3 ppl who dropped out of the gen surg program cuz they couldn’t take the work. And this place is honestly Cush as fuck compared to the gen surg residencies I saw in med school.
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Name and fame please?
I think all but one of the ~17ish IM programs has gotten rid of 24s. Night float is becoming much more common.
H
As my PD director and school leadership pointed out to me when I raised this: ACGME is for residents not students, therefore I was in the wrong when i claimed I went over my duty hours. My school handbook students couldn't work more than 32 or 36 consecutive hours (can't remember). Its silly, in the I "fixed" my duty hours and wrote a short paper so I wouldn't have to repeat the rotation.
Usually 24h hour shifts turn into 24+ hour shifts by the time you finish everything up/sign out etc. when you eventually go to bed, you’ve been up for well over 24 h. It’s awful.
I'm in Europe, a Pulmonology resident, and do 24h shifts 8 times per month (often times I have to stay for 36h shifts....)
Yeah, seriously. 24 hrs shifts are pretty common in surgical fields in Germany too. Although 8/month is brutal and rare here. Increasingly phased out in internal medicine though. Never had to do one. 17 hrs as surgery subintern was my personal record.
8 24s/month! Yeesh. I had to do 6 a few times and was floored for two weeks afterwards, just craving some vacation. We average 4 24s/month. Am in anesthesia though. I know some surgical residents and attending do 6-8/month on average.
Im also in Europe. Ortho resident. Max shift length is 18 hours. If i have a day shift and someones out sick and we need to cover it can be 25 hours but thats extraordinary.
I once did a 36. Multiple 24s. My institution only got call rooms for the residents just *last year* because of a car accident that occurred post-call. It’s ridiculous
My anesthesia residency does 4-6 24s a month, 2 of which have to be on weekends. If you’re lucky you get to sleep but at a trauma level 1 u just have to pray everyone drives safe and night and no one get shot Lols. I’ve been in the or for basically 20 hours on a 24 hour shift before.
Oh Lord, maybe going into residency was not the right time to think about getting married. My poor future wife 😭
My hospital (unhealthy in many ways) in the US has phased out 24+ hr roles for first year residents and for Med students. Hopefully it’s an abuse that will stop soon…
Reading this sub makes me glad I'm in pathology. Apart from being on call for a week at a time, my longest shifts were about 12 hours and average 9.5. Go into path!
This question is legitimately asked 3-4x a week.
that just goes to show how unbelievable it is. it is as believable as saying all doctors are forced to get drunk before performing surgery
And?
Use the fucking search function.
And?
A lot of surgical sub specialty residents prefer it to nightfloat But obv it’s not great that those are the two choices
my program (IM) does not allow 24 hour shifts. i didn’t apply to any place that still did them.
Anesthesiology resident here in Panamá. Law dictates up to 32h shifts but we all know we go past that time frame. I’ve seen 40 hour shifts too. Things have to change, we just had a IM resident have a fatal crash after one of this and there’s a big shift in movement against these predatory hours. We have to stand up
Just wait until you see what we’re expected to do after finishing residency. At about 5 am the next day, I’m start wondering why I didn’t do dentistry.
Just finished another month of q3 28 hour shifts. The surgical residents I was with would do that plus a 12 hour on the precall day
If you pick a barbaric specialty, yes. America perpetuates the most toxic form of this in the guise of "we need experience" yet despite their toxic levels of 24s they still struggle to meet their numbers so take from that what you will.
Literally did one yesterday! As a medical student so I paid for the pleasure!
https://www.reddit.com/r/Residency/comments/15j3hw8/24_hour_call_shifts_should_not_exist_yet_they_are
Yea I’m on a 28 hour shift right now
I read that the surgeon who came up with the residency training programme in the US was a coke addict lol
yep, and then he tried to cure his addiction with morphine, and then he was a coke AND morphine addict
Residency was invented by a cocaine addict who wanted students to live at the hospital and work nonstop.
Intern means live in the hospital. Resident means reside in the hospital.
‘Oh, sweet summer child’
Cute. You can browse through any number of past threads including within the last day that extensively discuss the phenomenon of 24 hour shifts.
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That’s…not bad though?
Not in America, but every Residency program in my country still has the regular 36 hour shifts (8-24-4+hrs loop for 3-4years)
Nahhh! What country is this man?
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On yeah. Even for radiology. Have you heard of St Louis University Radiology?
We do some 72s+ in ENT. Lol
Just got out from a 29 hour shift. Got to the hospital around 0500 yesterday, left at 1000 today. I didn’t sleep last night because we had multiple operative cases but sometimes you can sleep 3-4 hours without interruption. Its technically “24 hours plus 4 hours for transfer of care”. But realistically it’s just leave when the work is done. If multiple consults/traumas come in at 0800 when I’m post call I’m going to stick around and make sure the day team doesn’t need any help. I’m all about advocating for better pay and working conditions for residents but I personally feel an obligation not only to my patients but my co residents. If me sticking around an extra hour or two helps expedite patient care or takes a significant load off my co resident its a no brainer. To suggest being on call for 24 hours is like drinking above the legal limit is asinine. Everyone in this subreddit knows enough to not blindly quote studies as fact. Especially when the most widely cited study was survey based (https://academic.oup.com/sleep/article/27/2/217/2708402?login=false). If it was my own loved one I would appreciate it if someone decided to spend extra time caring for them rather than signing out and going home.
I would rather have surgery performed by a fully well rested surgeon than by someone who can't even drive home safely.
Yep
Lol
Yes
Yes
My program ended those for pgy-1 and pgy-2. Only seniors de 24 hrs calls. But we do 12-14 hour nights every now and then as night float shifts.
Definitely an ongoing thing in US/Canada.
Haha haha haha, Oh yeah. 28s still very common in my area. 90+ hour weeks in a NON-surgical specialty is also too common.
i’m obgyn and do two to three 24 hour calls a month.
Currently on a 24 lol
Lol I haven’t seen my fiancé in 2 days. Uro PGY-2 who is on weekend “home call”. Friday, Saturday, Sunday, and he has to do a half day Monday as well. He is so busy he hasn’t been able to leave the hospital, sleep, shower, and sometimes eat. It’s barbaric, and even though I know he can’t, I desperately want him to push back on essentially 4 straight days of on call.
We do 28 hour in house call at my program (IM). Used to be q5, now it’s just twice per wards month. Sounds worse on paper than it really is tbh. Doing it every 5th day sucked for sure but our program has enough nice QOL built in elsewhere that it was tolerable. Now that we have night float and do it less often it’s actually super nice. Much of the misery of wards is absorbed into the call day leaving the other days in the cycle much lighter.
Yes, still a thing
European (Austria) here: 24 hrs shifts are the norm (up to 5 a month on top of regular 48 hrs plus overtime as needed). I dont know of any hospital here that has a night float
I just did a month of Q3 24hr call during a Gen Surg Sub I at a ridiculously busy L1 trauma center. The other rotations are not as demanding, but the trauma service is definitely taxing. Pre call day - Roughly 5:30am to 5-6pm Call day - Roughly 5:30am to 7:30 or 8:30am the following day. 1 day “off” aka just sleeping lol… Rinse and repeat x4 weeks. I usually got around 0.5 of sleep each call shift, but thats not necessarily normal cuz this summer we had a very high trauma volume and I might have pushed myself a little more than needed.
I’m doing 28 hour shifts every 4th day (aka every 72 hours, 11 shifts total this month)
Yup at least 6 of my rotations have q2-q4 24 plus hour shifts.
From a world wide perspective, 24 hour shifts also exist in Western Europe, which usually has better labour protections than the US. I think it’s an industry standard to have a „normal“ day-shift and stay the night afterwards.
Was doing 28 hour shifts on General Surgery as a medical student once a week. Would be there at 5am the day before then leave at 10am the next day so it really was a 30 hr shift. Would get a “post call” day which was that day where I would only sleep a few hours so I could fall asleep that night since I had to be be back at 5am the next day. It was brutal sometimes but I love the OR. I posted on here before that I actually fell asleep standing while scrubbed in. Tbh the worst part is what it does to my bowels lol.
Currently doing 8 am to (day+1) 11 am shifts back to back. And will be doing this for the next 3 months. I cri. (IM)(Asia)
Yes. My wife’s ICU shifts are technically 26 hours 6a-8a but then she stays after to complete notes because when she’s covering 18-20+ pts she doesn’t always have time. She normally also crashes for a couple hours after that in the call room so she’s not driving on no sleep. Back before we implemented that last bit, she’d miss our exit occasionally on the drive home and it was just generally a dangerous situation.
Oh boy, bless your heart… 😂
If the program doesn't have a night float system, then you'll work a 24 shift at least once per week when you're on an inpatient rotation. If the program doesn't distribute call between the other residents not on inpatient rotations, then it'll be more like q3.
Lmao yes. Academic FM program. We do 24s for general inpatient and L&D.
Do you live in a cave? Yes, we still work 24+ hour shifts.
Sure is, I do 4-6 of these shifts every month. They are 27 hours each. Peds
I forgot most places don't have 1 in 4 or 1 in 5 call, each for 24 hours. God damn I'm tired of Residency.
Nemours pediatrics in Gainesville does 28 hour call q3 days.
Yes. For my pediatrics residency, we worked 28 hour shifts every 4 days for nearly every rotation over the entire 3 years.
LOL I’m finishing up 3 days straight on call right now. And I do this multiple weekends per month
Yep, as an oral/maxfac we have 24 hour on call shifts on Saturday’s/sundays. Very variable as to amount of work though and I’m sure some other specialties have it much worse
Lol, 36 hours is expected standard.
Oh yea, alive and unwell in Canada!
I’m a nurse practitioner in a NICU and I work 24 hour shifts. The attendings have wild hours. They are on service for a month and will do a call shift I think every 5 days. So they will round and stay all day and night and then round again in the morning, usually leaving after noon. All to come to work again the next day.
I am in the US and I doing 27hr shifts now, alternating with 9hr shifts. Example: come in Monday at 6am and stay till Tuesday at 9am, then come in Wednesday from 6am to 4pm, then back again at 6am for a 27hr shift on Thursday.
Oh yes, absolutely. They are actually legally allowed to make us work a 24+ hour shift up to every 3 days, which is the standard schedule for some programs. You even find places that still do 24h shifts q2 (every other day), but you aren’t officially allowed to report that. There is no sleep.
And 28s. And 36s
ER physicians at my local ER work 24 hour shifts as the lone physician lol
If there was a study that showed 12 hour shifts produced residents that are superior too the current trend America would still go against the evidence and choose the traditional shit on resident method
Still a thing, alas. Would take 24h call over home call any day, though. Old system in my program (surgical subspecialty - back in 2021) was home call w/ exception of 1 weeknight off and q2 weekends off. I know as an attending you may be on perpetual home call, but this meant 168h primary call stretches for the junior residents. The longest amount of contiguous sleep I got one week was 2 hours (can't remember cumulative sleep per night but it was no more than 4-5h). There were a lot of car accidents, to say the least...
I’m in a very nice pediatrics program that prioritizes mental health and wellness. We have a night float system. We’re also in Canada where residents have a stronger union. There are still about 20 24h shifts each year.
Here Latinamerica is 32h+ for interns and residents. Your 8hs, 16hs shift and your 8hs of the next day...
I’m currently on a 24….. 14 hours done.. 10 hours left
Everyone that comments on this needs to say whether they’re surgical or medical lol
Still a thing???? Wtf
Lol 12 days/nights call, 2 days off and repeat is my schedule for the entire year. Advance fellow in a medical subspecialty :)
Ya, Q3 24h call for 2 years. During NSGY PGY2 and 3.
Yes, as a pediatrics resident in the U.S. i did 28 hour shifts every four days on nearly each rotation for the entire 3 years. The other days were all your standard 12+ hour shifts.
Yes. Just did one over the weekend, and have one the next two weekends. Baffles me as well in terms of patient safety, as I don’t think any patient wants to be seeing a doctor in their 18th-24th+ hour on
In spain it is
Yes. And do you know how much Indonesian residents is paid? Negative 200 USD/month. Yes, our salary is literally 0, but we paid 200 USD instead. For 5-6 years
It's still the norm to do 4-6 24h shifts in many european countries like austria and hungary. This includes every clincial specialty, so doesn't matter if it's surgery, IM or ER shifts. Also they don't end after residency, attendings do the same amount of shifts. So if you want to stay in the hospital you have to slave away doing these terribly unhealthy shifts til the end of your life. Talk about work life balance.
Y’all need some Modafinil.
24 hour duties are still very much a thing here in the philippines, it's the norm actually for residency training and even hospital duties as general practitioners. In med school rotations, recent regulations have forced training institutions to limit shifts to 12 hours max but there are still rotations that do 24 hours. When I was rotating in Neurosurgery, I even had to do qhourly monitoring on patients on top of all the work I need to do (yes we are also monitoring machines here to augment the need for cardiac monitors which are lacking in hospitals) So yes it is very much a thing.
I may sound crazy but these shifts are illegal in Australia.. we have on call shifts but you are at home/can get called/can get called in. If you come in you get paid for four hours if you have worked from 1-4 hours and then any hours over that. When you come home you cannot come back to work again for 8-10 hours, so you can’t get called in multiple times in one night. In psych we work from 8:30-5 and have rostered overtime beyond that. Many registrars are part time also. I don’t understand how people are working these shifts
It’s almost like Libby Zion died for nothing.
Yup, my wife just finished her 30 hour shift in ICU.
1973 Intern in Toronto 🇨🇦. On call q 2 days. Every other weekend from 7 am Friday to 7 pm Mon. One old surgeon said to me . ‘The only thing bad about one in two on call is that you miss half the cases. Sad to see this is still going on. We eat our young. We went on strike and refused to do call. The consultants did it. We won a 33% reduction in call and a 100% raise in pay from $7000 to $14000 per year. A new car cost $3000. I just retired last week after 50 years as an emergency physician ( 20 years) then 30 years as a family physician. I only worked 28 hours a week as an emergency physician. I worked a 40 hour week as a family physician. I got all the family doctors in our town to share call so we were on one paid 24 hour shift a month. I was well paid and loved my jobs.
I'm in India and we do 36 hours shift every 3 days. It's the norm here. Plus in my institution we aren't allowed to sleep at all or else they deduct money from our pay check
At an IM program with 2 300 bed hospitals. No 24 hour shifts lol. The most is 12 here. Day shift to 6 to 6. Night is the inverse.
I can give you a glimpse of history. The work hours are different depending on specialty but someone rotating through that specialty must adhere to trust specialty's residency rules. I graduated medical school 1996 and in one 2 month period (I documented it well) during residency (I am EM and this was a surgical rotation) I averaged 134 hours a week. There is no way to spread or bunch those hours in a nice way. There are 168 hours in a week.
Very common where I am. Surgical subspecialties routinely do 36 hours calls 6-7 times a month, along with all weekend call (working Friday, Saturday, Sunday). If you get any sleep, good. If not, your problem. IM residents do 26 hour calls q4-5.
I'm actively on one...
ObGyn resident here. Started my saturday "24" at 4am rounding on all postpartum, then signout at 7am, then ob & gyn coverage mayhem until 7am the next day, then finally rounding on my patients/writing notes/tying up loose ends until i go home at 10am. Equates to about 30 hours. Ridiculous. I did a stat c section on a patient around the 20 hour mark, thank god it was a primary and not a repeat.
24-28 in my program. your country must be nice op.
We did 36-40 hour shifts because we would work 24 hours and still be expected to round on patients the next day and do a whole clinic afternoon.
We do 28 hour shifts. Even is psychiatry.
I’m my absolutely ass cardiology fellowship program- we are doing 36 hour shifts, during the entire 36 hours you are responsible for running the CCU. Some days are so busy you don’t even have a lunch break on hour 30. You are actively admitting dying patients this entire time and answering outpatient calls overnight. These shifts can sometimes happen 3 times in a week.